Patient Safety and Ethical Issues in High Dependency Unit Nursing Practice

This article discusses the role of registered nurses in high dependency units, burnout as a safety concern, ethical issues in nursing practice, and the importance of patient confidentiality. It also highlights the impact of burnout on patient care quality and the need for nurses to enhance their competencies in patient safety and ethical principles.

Name
Student ID Number
Module:
NRSG 370 Assessment 3
Topic:
Specialty area
High Dependency Unit
Number of Words

2
Module 1
The role of registered nurses across the clinical field is crucial in the delivery of care.
Registered nurses offer patient-centered care using evidence-based research. They are tasked
with providing the patient with care continuum and support the patient towards achieving the
needed health outcomes. Further, the RN is tasked with leadership in areas of specialty and
coordination of care for the benefit of the patient. Further, in informing clinical expertise, RN
offers assistance to clinicians and practicing students in maintaining professional
development and meeting the set standards for nurses which guides their practice, (Kendall-
Gallergher & Blegen, 2009).
One of the critical issues of safety I experienced at the high dependency unit- HDU
entails the issue of burn out. Burn out has been referred to as prolong exposure to chronic and
interpersonal stress experienced on the job and soften due to excessive usage of work at the
facility, (Burgess, Irvine & Wallymahmed, 2010). Burn out has been referred to as an
occupational hazard not only in the medical nursing field but also various oriented
professions. Nursing burnouts can have an effect on the wellbeing of the worker.
Burnouts at the high dependency units often emanate from work-related stress and these
symptoms have been termed as frequent. Burn out reflect a psychological issue which
response to long-term interpersonal and emotional stressors.
In my practice, experiencing burn out seems to be the challenge to cope, as it was
draining my energy thus affecting my overall well being. This can have are purchase on the
nature of health care quality on my professional care I provide.
Burn out prevalence has been associated with a high workload and time pressure. With
intensive care unit composition, the work load is high and critical care is needed, thus at risks
of experiencing of this effect. In my placement at the high dependency unit, there are several
issues of concern which ouch on the safety of the registered nurse. High dependency units are
often occasioned by high job discrepancies, overload responsibilities, end of life issues and
interpersonal conflicts which affect and lead to high burn out cases, (Szecseny et al., 2011).
Intensive care units often provide support and treatment to critically ill patients.
Registered nurses in this section often have feelings dissatisfaction due to burn out often

3
occasioned by the high workload. Research has shown that this issue often leads to lower job
performance. Registered nurses working at high dependency units and ICU have been shown
to have high prevalence and score high rates in terms of burn rates, (Garland, Roberts &
Graff, 2012).
Burn out in the high dependency unit is associated with reducing and declining quality of
care and lower patient satisfaction, increased incidence of medical errors, high infection rates
and increased 30 days patient mortality rates. Burn out is often attributed to the working
environment which the registered nurse is often exposed to. In ICU faculties, there is elevated
patient morbidity and death occurrence. Further in a more extensive effect, health care
professionals on experience post-traumatic stress disorders which affect their overall work
quality., (all, Azoouly, Embriaco Poncet & Pochard, 2011).
High dependency unit often is characterised by highly stressful environment which has
effects on the safety of the registered nurse and also the health concern for the patient on the
quality of care being provided at. Enhancing nurses knowledge on job satisfaction and
burnout in the nursing profession is key in focusing on patient care quality, nurse staff
turnover, and poor communication, (Verdon, Merlani, Perneger & Ricou, 2008).
Hence as I enter into profession there is a need for me to be cognizant of the eminent
safety factors which can arise at the curse of my workplace. Having adequate skills and
effective coping mechanisms will be essential in my placement service at the high
dependency unit.
Module two
High dependency units often exhibit a high change environment where expensive care is
offered to patients who are critically ill. Ethical issues are more prevalent in these units
especially among the different personnel involved there. Registered nurses at the high
dependency unit thus need to show ethical competency. Critical areas of concern which are
concern range from behavioral issues such as an end of life decision issues, respect,
autonomy and poor communication between the different levels of staffs. Often medical
criteria which play a fundamental role in nursing care revolve around the decision of wrong
or right, or even being faced with conflict which arises from patient care process, (Tapper,
Vercler, Cruze & Sexson, 2010).

4
Confidentiality in the high dependency unit is often important because of information
sharing among health care professionals. If this patient information is not protected, the
nurse-patient relationship can be diminished. Often patients don’t want their information to
be shared, thus creating a trusting environment through respect to patient information and
encouraging the patient to be honest on delivering healthcare information, (Park et al., 2015).
In high dependency units, the obligation of confidentiality often calls for the prohibition
of nurses from disclosing patient information without permission. Appropriate care often
calls for information regarding the patient to be discussed among the healthcare team. All
healthcare team have the rights to access patient information and assume the duty of
protecting the information. However medical electronic information needed adequate data
protection policies which ensure patient confidentiality, (Truog et al., 2008).
Nurses in the HDU, can at times face ethical dilemmas when family members request to
be disclosing information regarding their kin. At time unintended disclosures can be done
among patients in this unit. A case example in high dependency unit is when a patient
requires an urgent attention which calls for an urgent discussion and has the potential benefit
of alleviating an individual from any danger. In this case, determining principle factor often is
whether the perceived threat causes more harm than a danger to the patients, (Merlani et al.,
2011).
There have been overriding situations which call for breach of confidentiality on high
dependency unit. When the safety of the patient is breached, confidentiality tends to be
broken. This can guarantee for access to high dependency unit patient access on medical
information and data. However, in this, nurses often have the sole responsibility of protecting
patients from credible threat and harm if they hold information which is key to their safety.
The often crucial factor is whether there is a good reason for believing whether the threat is
of any danger to the patient, (Yun et al., 2011). Here developing this skill of identifying
potential risks of an ethical concern is of great importance in nursing practice at the high
dependency unit.
Another fundamental reason which often needs a breach of confidentiality is legal
requirements in a system of justice. State laws have outlined that any threat to public health
warrant for disclosure of patient information. State and its organs have the jurisdiction of
protecting the greater public from harm and any danger.

5
Module Three
Reporting
My reflection entails my nursing practice as a registered nurse at the high dependency
unit offering critical; care to patients. In, high dependency unit, a lot of activities are involved
which emanate from offering best care services to the patient. The issue which occurred
during my practice involved healthcare ethical issue. In this case, the ethical challenge arose
where challenge occurred with respect to breaching patient information. The issue involved
sharing patient information to patient relative despite no approval request from the patient.
This was a total breach of patient information.
Responding
My feelings regarding this issue made me feel not comfortable and felt that I had
betrayed patient data information felt to have betrayed patient information and data. This
action made me feel disoriented and felt that the information I had shared could be used to
harm the patient. This is in line with a nursing ethical practice which calls for patient privacy
to adhere to all healthcare staff. However as much as I felt disoriented, I asked myself critical
questions regarding whether patient close next of kin has a right to patient information. This
failure to act on this case led to an act of breach on patient confidentiality which can pose
significant harm to nurse-patient privacy process.
Relating
My understanding of ethical practice is that it is key in healthcare practice and it is
essential in enhancing and promoting patient relationship. Ethical dilemmas often arise in
health care and are more critical when the healthcare professionals are faced with challenges
to disclose patient information to close relatives of the patient. Patient confidentiality is a key
aspect in healthcare practice, and as a nurse, there is a need for me to acquaint myself with
these principles and to follow effectively so as to enhance and foster a nurse-patient
relationship in the high dependency unit.
Reasoning

6
According to Principles of Nursing profession, ethical decisions and practices are
essential and fundamental to nursing practice. There is a need for al nurses to respect patients
and offer dignity in their care practices. Nurse need to create environments which built on
mutual trusts and enhances respect for the patient and other relevant health care professionals
in the unit. Maintaining confidentiality of patient is core nursing practice as it promotes the
nursing practice and enhances patient outcome levels. Ethics of confidentiality promotes
cooperation and collaboration between staffs. Breach of patient confidentiality could have
negative impacts on patient quality of care and harms the relationship initiated at the unit.
Reconstruction
Developing and understanding patient safety and ethical principles in nursing practice,
there is a need for me to enhance and improve my competencies in these areas. Identifying
and having knowledge on coping measures which are necessary for coming up with burn out
effects as a safety concern in nursing practice. Understanding the effects of burning out and
identifying avenues which could be mitigated plays a crucial role in enhancing positive
patient outcome and assuring the safety of health care professional concerned. Further en-
calculating ethical principles and practices in my overall career as a registered nurse at the
high dependency unit is critical so as to foster positive association and collaboration with the
patient thus improving overall health outcome.

7
References
Burgess, L., Irvine, F., & Wallymahmed, A. (2010). Personality, stress and coping in
intensive care nurses: a descriptive exploratory study. Nursing in critical care, 15(3),
129-140.
Garland, A., Roberts, D., & Graff, L. (2012). Twenty-four–Hour Intensivist Presence: A Pilot
Study of Effects on Intensive Care Unit Patients, Families, Doctors, and Nurses.
American journal of respiratory and critical care medicine, 185(7), 738-743.
Kendall-Gallagher, D., & Blegen, M. A. (2009). Competence and certification of registered
nurses and safety of patients in intensive care units. American Journal of Critical Care,
18(2), 106-113.
Le, J. G., Azoulay, E., Embriaco, N., Poncet, M. C., & Pochard, F. (2011). Burn out
syndrome among critical care workers. Bulletin de l'Academie nationale de
medecine, 195(2), 389-97..
Merlani, P., Verdon, M., Businger, A., Domenighetti, G., Pargger, H., & Ricou, B. (2011).
Burnout in ICU caregivers: a multicenter study of factors associated to centers.
American journal of respiratory and critical care medicine, 184(10), 1140-1146.
Park, D. W., Moon, J. Y., Ku, E. Y., Kim, S. J., Koo, Y. M., Kim, O. J., ... & Koh, Y. (2015).
Ethical issues recognized by critical care nurses in the intensive care units of a
tertiary hospital during two separate periods. Journal of Korean medical science,
30(4), 495-501.
Szecsenyi, J., Goetz, K., Campbell, S., Broge, B., Reuschenbach, B., & Wensing, M. (2011).
Is the job satisfaction of primary care team members associated with patient
satisfaction?. BMJ quality & safety, bmjqs-2009.
Tapper, E. B., Vercler, C. J., Cruze, D., & Sexson, W. (2010, May). Ethics consultation at a
large urban public teaching hospital. In Mayo Clinic Proceedings (Vol. 85, No. 5,
pp. 433-438). Elsevier.
Truog, R. D., Campbell, M. L., Curtis, J. R., Haas, C. E., Luce, J. M., Rubenfeld, G. D., ... &
Kaufman, D. C. (2008). Recommendations for end-of-life care in the intensive care

8
unit: a consensus statement by the American College of Critical Care Medicine.
Critical care medicine, 36(3), 953-963.
Verdon, M., Merlani, P., Perneger, T., & Ricou, B. (2008). Burnout in a surgical ICU team.
Intensive care medicine, 34(1), 152-156.
Yun, Y. H., Lee, M. K., Kim, S. Y., Lee, W. J., Jung, K. H., Do, Y. R., ... & Jeong, H. S.
(2011). Impact of awareness of terminal illness and use of palliative care or intensive
care unit on the survival of terminally ill patients with cancer: prospective cohort
study. Journal of Clinical Oncology, 29(18), 2474-2480.